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The past three posts have received an overwhelming response, and I am so incredibly grateful. It means so much to me that my story is touching so many people and increasing understanding of eating disorders, so THANK YOU for reading! Today, I want to get back to basics a little bit and talk to you about eating disorders in general – the signs, symptoms, contributing causes, and some statistics  – because so many people just think of super skinny women when they think of the “face” of eating disorders, and that is not the entire reality.

The Harsh Reality

Eating disorders have the highest mortality rate of any mental illness. Higher than depression, schizophrenia, post-traumatic stress disorder. A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5 – 10% of anorexics die within 10 years after contracting the disease and 18-20% of anorexics will be dead after 20 years, and 20% of people suffering from anorexia will die prematurely from complications related to their eating disorder, including suicide and heart problems. Similarly elevated rates are found among those suffering from bulimia.

Twenty percent of us. One in five.

People suffering from bulimia are more likely to commit suicide than any of the other disorders.

As you might expect, the average age of onset is in the adolescent years, particularly during the early teenage years. However, eating disorders are being recognized in patients during childhood – we’re talking 9 year olds here. It’s incredibly important to recognize warning signs early, because the earlier treatment begins, the greater the chances are for recovery.

My parents hate my tattoos, but I like this one.

Anorexia Nervosa

The clinical name for anorexia is Anorexia Nervosa, which is probably the eating disorder people are the most familiar with because it is the most physically noticeable, with sufferers generally becoming very thin. Warning signs of anorexia include:

  • Dramatic weight loss.
  • Preoccupation with weight, food, calories, fat grams, and dieting.
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
  • Frequent comments about feeling “fat” or overweight despite weight loss.
  • Anxiety about gaining weight or being “fat.”
  • Read the whole list of warning signs here.

The official diagnosis of anorexia comes with the following symptoms:

  • Resistance to maintaining body weight at or above a minimally normal weight for age and height.
  • Intense fear of weight gain or being “fat,” even though underweight.
  • Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight.
  • Loss of menstrual periods in girls and women post-puberty.

We’ve already gone over some of the health consequences of anorexia, which can ultimately result in heart attack or death.  I’m trying not to be too excessive with the bullet lists, since we’ve got a long way to go. About 90-95% of anorexia sufferers are women, which means that a lot more men than you’d think suffer from the disease. It is estimated that about 1 in 200 American women suffers from anorexia. While the numbers of male sufferers are smaller, this is the group least likely to receive treatment because anorexia is thought of as being a “female” disease.

This article does the best job I’ve seen describing the way anorexics see themselves.

Bulimia Nervosa

Bulimia Nervosa, the medical name for bulimia, is characterized by the National Eating Disorder Association as a “serious, potentially life-threatening eating disorder characterized by a cycle of binging and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.” Warning signs of bulimia are more numerous than anorexia, but often go unnoticed:

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
  • Unusual swelling of the cheeks or jaw area.
  • Calluses on the back of the hands and knuckles from self-induced vomiting.
  • Discoloration or staining of the teeth.
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.

The vast majority of bulimia sufferers appear to be of average body weight or are slightly overweight, which is part of why the disease is so easy to hide. People expect eating disorder patients to be extremely skinny, but this is actually only a hallmark of anorexia. The symptoms of bulimia that ultimately lead to diagnosis are:

  • Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
  • Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
  • Extreme concern with body weight and shape.

Again, we’ve already discussed some of the health consequences of bulimia, but one of the most serious is electrolyte imbalances that can lead to irregular heartbeats, heart failure, and death. Bulimia is more common than anorexia, with about 2% of American women suffering, and many bulimia sufferers are aware of the health consequences of the disorder and choose to ignore it.

Terri Schiavo, before and after. You may remember her from her “right to live/die” case, but Terri Schiavo had a heart attack caused by an electrolyte imbalance as a result of bulimia. The lack of oxygen to her brain left her brain dead.

Unlike anorexia, only 80% of bulimia sufferers are female. While I obviously can’t speak to the suffering of men with bulimia, something my ex-husband said to me once sticks with me. When I tried to explain to him how serious my eating disorder was at the time and why I needed more in depth therapy at the time, his response was “I don’t really see what the big deal is. All wrestlers throw up all the time during wrestling season to make weight and you don’t see us in therapy.” Aside from the fact that he’s obviously an asshole, it got me thinking. How many wrestlers, jockeys, boxers, MMA fighters, whoever, are ending up with eating disorders? That’s definitely not your average skinny girl.

Binge Eating Disorder

Binge eating disorder is the most recently added to the list of clinically recognized eating disorders (as of May 2013), and it is the one that affects the largest number of people. Up to 5% of Americans are said to suffer from binge eating disorder, which is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating. The symptoms of binge eating disorder include:

  • Frequent episodes of eating large quantities of food in short periods of time.
  • Feeling out of control over eating behavior during the episode.
  • Feeling depressed, guilty, or disgusted by the behavior.
  • There are also several behavioral indicators of BED including eating when not hungry, eating alone because of embarrassment over quantities consumed, eating until uncomfortably full.

The health consequences of Binge Eating Disorder basically mirror those of clinical obesity, including high cholesterol, high blood pressure,  heart disease, diabetes, etc. That being said, not all people with Binge Eating Disoder are overweight. While I don’t have any experience with Binge Eating Disorder, the woman who inspired me to write my “Life with Ed” series does. Her name is Emily, and she suffered from binge eating disorder for 13 years. Her “Life of a Binge Eater” series does a fantastic job of describing what it’s like to deal with binge eating disorder, so check it out. I think it’s fascinating! You can even see that I pretty much stole her disclaimer because I thought it was perfect.

A typical day of food for Emily during the height of her disorder

Of all of the eating disorders, I think that Binge Eating Disorder probably gets the worst rep and has the biggest misconceptions surrounding it. I mean, how many of you read those symptoms and your first thought was “yeah right, that’s just all fat people?” The reality is that the same compulsion that causes me to lose control of my tendency to restrict, purge, etc is the one that causes some people to binge eat in massive quantities. In the same way that not all thin people have an eating disorder, not all overweight people have an eating disorder.

Eating Disorder Not Otherwise Specified (ED-NOS)

Ah, my Ed. ED-NOS is basically a diagnosis given to people who exhibit a combination of the behaviors associated with anorexia and bulimia. Each case looks different, but the health consequences are just as serious and will reflect the specific symptoms of each individual.

This isn’t really relevant to the “back to basics” concept of this post, but it’s my blog, so screw it. I will never forget receiving my diagnosis of ED-NOS, but not for the reasons you might think. I remember it because I felt a combination of sad and incredibly angry when they told me. I felt like a failure because I didn’t fit into a “real” category.  I wasn’t anorexic and I wasn’t bulimic; I was some fake disorder called ED-NOS that they just gave to people who weren’t really sick. That’s honestly how it felt. It felt like I wasn’t good enough to have a “real” eating disorder. As I’ve touched on in previous posts, there’s a sense of pride and competition within the ED community. We all want to be the “best” or the “strongest” or “the one with the most will power.” You don’t even have to have ever spoken to another patient to feel that way. Maybe it’s built into our (stereotyping here) Type-A personalities to feel that way. Anyway, that has nothing to do with anything, just thought I’d give you some further insight into my twisted mind.

The Takeaway

We don’t all look the same, but we’re all just as sick. Early detection and treatment is the best chance anyone has for recovery, just like every other disease, so know what to look for! In an upcoming post, I’ll talk about what to say (and just as importantly, what not to say) to someone who is suffering.

COMMENT: I’ll be doing a question and answer blog to wrap everything up at the end of the series (which is still several posts away). Ask me anything eating disorder related – it can be about me or just general knowledge or whatever you want – and I’ll do my best to answer it. Leave a comment with your question or email it to and I’ll add it to the list!

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